A key part of the health care overhaul is to insure at least 30 million more Americans. But there may not be enough primary care doctors to treat them.
Primary care doctors are the doctors you call when you first start feeling sick. They're family doctors, general practitioners, and pediatricians, for example.
Lori Heim, president of the American Academy of Family Physicians, says they're critically important, but there aren't enough of them to go around.
"We know we don't have enough primary care physicians to take care of even our current workload," said Heim. "And we're talking about 31 million new U.S. residents who would be able to have insurance."
The Association of American Medical Colleges says Minnesota ranks 11th nationally in the number of primary care doctors compared to other states, but there still aren't enough to meet demand.
Bemidji physician Bob Rutka says luring primary care doctors to rural areas is even more difficult, and health care reform won't rapidly change that.
"It's much quicker to build buildings or to build a clinic. But to staff that clinic -- workforce shortages are a very real thing now, and it takes some investment and probably a change in thought processes," said Rutka.
“If you're smart enough, you become a specialist. If you've got a big heart, you'll become a primary care person.”Bemidji physician Bob Rutka, quoting other doctors
The major reason for the shortage is financial. By most standards, primary care doctors make good money -- they start at about $150,000 per year. But context is everything.
Medical school is rigorous and expensive. The Association of American Medical Colleges says med school students graduate with a debt that averages about $140,000.
Then consider that with training in a specialty like cardiology, a graduate can earn two or even three times more than a primary care doctor.
The health care bill raises the amount primary care physicians would be paid for treating Medicaid patients. Those rates are often lower than private insurance and Medicare payments.
The bill would raise Medicaid payments to the same as Medicare rates. It would also give physicians who practice primary care up to 10 percent in bonuses.
Additionally, it would increase student loan forgiveness and scholarships and expand the National Health Service Corps, which also provides loan repayment for health workers in shortage areas like primary care.
Rutka, the physician in Bemidji, says those incentives are enticing, but he says the medical profession also needs to address the challenge within its own ranks -- that doctors who practice family medicine don't always get the same respect as specialists.
"Part of that is our own doing. But in our training process, we're trained by specialists, even in general medicine, because those are the people that we need to learn specific skills from," said Rutka. "Often times they'll say, if you're smart enough, you become a specialist. If you've got a big heart, you'll become a primary care person."
Deanna Okrent, senior health policy analyst for the Alliance for Health Reform, says the health care bill calls for a special committee to study primary care training, supply and demand.
"Their objective would be to implement a national health workforce strategy," said Okrent. "So there are actually funds that would be appropriated in fiscal year 2011 for the committee and the study."
For example, that committee would study why some areas of the country retain doctors to work in rural areas and others don't, and how to encourage medical schools to change their curriculums to attract more students to primary care.
Most important, the committee will determine how many doctors, and what kinds of doctors, the nation needs.